Post-discharge support is a key component of effective treatment for hospitalized smokers, but very few hospitals provide it. Linking hospitalized smokers with free, proactive tobacco quitlines is an ideal way to provide supportive contact at discharge, because quitlines are effective and cost effective for smoking cessation. Many hospitals are beginning to fax-refer smokers to quitlines at discharge. Fax referral is convenient and is part of the current culture of medical communication channels. However, less than half of fax-referred smokers are successfully contacted and enrolled in quitline services. Warm hand-off is a novel approach to care transitions in which health care providers directly link patients that have substance abuse and mental health problems with specialists, using face-to-face or phone transfer. Warm hand-off achieves very high rates of treatment enrollment for these highly vulnerable groups. The objective of this application is to determine the relative effectiveness, and cost-effectiveness, of warm hand- off versus fax referral for linking hospitalized smokers with tobacco quitlines. This study employs a two-arm, individually randomized design. It is set in two large Kansas hospitals that have dedicated tobacco treatment interventionists on staff. We hypothesize that warm hand-off will outperform fax referral by achieving higher rates of smoking cessation. Warm hand-off will boost abstinence by increasing quitline enrollment and adherence among smokers. Outcome measures will be assessed at 12-months post enrollment. The project includes contracts with the State of Kansas and its quitline vendor. Free & Clear, to obtain data on participants' quitline enrollment and adherence. Costs will be thoroughly assessed to support cost-effectiveness analyses. If successful, this project offers a potential low-cost solution for more efficiently linking millions of hospitalized smokers with effective outpatient treatment-smokers that might otherwise be lost in the transition to outpatient care. (End of Abstract)